Longitudinal associations between the retail food environment, diet quality, and chronic disease risk among Black and White young adults in the United States

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  • March 22, 2019
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  • Zamora, Daisy
    • Affiliation: Gillings School of Global Public Health, Department of Nutrition
Abstract
  • The recognition of the public health and economic consequences of nutrition-related chronic diseases has led to policies focused on improving the diets of the population subgroups at highest risk: low-income people and African Americans. Sometimes, however, the evidence base for these policies is weak. For example, in response to research suggesting that low-income areas have less access to affordable and nutritious foods, policy interventions have been proposed to address this access disparity; however, this association is far from well established. Similarly, the Dietary Guidelines for Americans (DGA) are widely promoted in public health campaigns, yet there is surprisingly little evidence that following them is effective at reducing risk of chronic disease in the general population, in part because most past studies have been cross-sectional, demographically homogeneous, or conceptually flawed (e.g., potential for reverse causality). Our research fills important substantive gaps in the understanding of these relationships using data from a geographically diverse cohort of Black and White young adults (followed from 1985 to 2005) and analytic methods that exploit the longitudinal structure of the data. First, we examined the longitudinal association between neighborhood socio-demographics and the availability of foods stores. We found that poor and high minority areas had higher availability of supermarkets and grocery stores. This suggests that, contrary to common assumption, stores where healthy foods can typically be purchased are available to the subgroups at highest risk. Second, we examined the prospective association between adherence to the 2005 DGA and risk of major weight gain, diabetes, and progression of other cardio-metabolic risk factors. Overall, we found little evidence that a higher diet quality led to better long-term health (except for blood pressure and HDL cholesterol outcomes). In Whites, higher diet quality was associated with less 20-year weight gain, but unrelated to diabetes incidence or insulin resistance. However, in Blacks, higher diet quality was associated with greater 20-year weight gain, and with slightly higher incidence of diabetes and increase in insulin resistance. Results of this research highlight the urgent need for effectiveness trials of the DGA.
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  • ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Nutrition of the Gillings School of Global Public Health.
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  • Popkin, Barry
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